Infection Control Today

MAY 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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6 ICT May 2019 editor's letter EDITORIAL EDITOR IN CHIEF Kelly M. Pyrek S ALE S/MARK E TING GROUP PUBLISHER William Mulderry PUBLISHER John Currid SUBSCRIPTION CUSTOMER SERVICE 800-581-1811 PRODUC TION ART DIRECTOR Robert Rys AD PRODUCTION MANAGER Bonnie Streit DIRECTOR PUBLICATIONS Joseph Chackola HUMAN RESOURCES DIRECTOR Donna Layton INFORMA E XHIBITIONS LLC 2020 N. Central Ave., Ste. 400 Phoenix, AZ 85004 Phone: 480-867-7943 Web: Could Subsidies for Infection Control to Healthcare Institutions Reduce HAIs? Kelly M. Pyrek Editor in Chief S hould infection prevention and control be subsidized? That's the focus of a recent paper issued by researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) and Princeton University, who explored whether fi nancial subsidies and other forms of monetary compensation to healthcare facilities could encourage infection control measures. They developed a game-theory model of epidemiology and hospital behavior to assess the impact of different forms of subsidies on hospitals' infection control. Researchers compared three types of subsidies: a subsidy tied to the number of uninfected patients, which is equivalent to a tax on infected patients; a fi xed subsidy; and a dollar-for-dollar matching subsidy. Under a limited budget, researchers found that a dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections. In hospitals with high transmission and/ or high levels of patients with infections on admission, a matching subsidy resulted in a hospital increasing its own spending. Additionally, in a two-hospital model, researchers demonstrated that subsidies should be preferentially given to hospitals with lower transmission rates to improve infection control for both facilities. "We need to fi nd ways to improve infection control in US hospitals, and fi nancial incentives could provide a strong motivation" says Ramanan Laxminarayan, director of the CDDEP director and senior author on the study. "The cost of infection control is small compared to the tremendous cost-reduction that could be achieved across the system." The researchers observe, "In our study, we observed two kinds of behaviors on the part of hospitals: Free riders spend less when offered funding, and cooperators spend more when offered funding. An intuitive approach to deploying scarce subsidy resources might be to offer encouragement to a hospital that increases spending when others do. However, the results of our mathematical model suggest that in a two-hospital system, incentivizing the institution with a lower transmission rate is better for the overall outcome of the system. Since this two-player game acts as a case study in subsidy allocation, future work should explore the nuances of more complex network combinations of n hospitals with various transmission functions. Furthermore, an optimal control model may be able to tease apart the feedbacks between local and global infection control efforts as well as the differences between optimal and suboptimal spending conditions. In the context of this paper, the group that has the lower transmission rate should receive the incentive. This group is closest to eradicating the infection and significantly reduces the proportion of patients infected in the community. In effect, this is focusing on reducing the local infection in a single patch to reduce the total global prevalence. Individuals colonized in the community play a large role in the transmission dynamics and so reducing the community prevalence is most effective at reducing the global prevalence. If the money from a subsidy was split, then there would not be as strong an impact on patients admitted already colonized. Thus, the marginal return on an additional subsidy dollar is much higher for a lower transmission rate." Within the overlap of epidemiology and economics, the researchers say their fi ndings provide another example of the way in which incentives can alter behavior — sometimes in unexpected ways — and fundamentally change the outcome of an epidemic. They offer a model that can guide policymakers in enacting subsidy programs which result in encouraging investment in hospital infection control. Until next month, bust those bugs! Reference: Drohan SE, Levin SA, Grenfell BT and Laxminarayan R. Incentivizing hospital infection control. Proceedings of the National Academy of Sciences. Ppublished ahead of print March 11, 2019. pnas.1812231116

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